Regarding “Cutaneous vascularization of the femoral triangle in respect to groin incisions”

Abstract

Tremblay et al provide a thorough and interesting analysis of the blood supply to the tissues overlying the groin, further informing the debate on the optimal incision for exposing the femoral vessels.1Tremblay C. Grabs D. Bourgouin D. Bronchti G. Cutaneous vascularization of the femoral triangle in respect to groin incisions.J Vasc Surg. 2016; 64: 757-764Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar Whereas the oblique incision is associated with fewer wound complications, the much-favored vertical incision over the femoral artery generally affords better access to the vessel and is easily extended in either direction should more proximal or distal control prove necessary.2Swinnen J. Chao A. Tiwari A. Crozier J. Vicaretti M. Fletcher J. Vertical or transverse incisions for access to the femoral artery: a randomized control study.Ann Vasc Surg. 2010; 24: 336-341Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar With the intention of causing the least possible cutaneous vascular insult, they propose that the ideal incision be placed lateral and distal to the standard. However, this could make the proximal common femoral and distal external iliac arteries difficult to access and would render harvest of the long saphenous vein more complicated. We routinely use a “lazy S”-shaped incision to access the femoral vessels; an oblique 3-cm incision is made just below the inguinal ligament, centered over the femoral artery, which is then extended vertically, both inferomedially and superolaterally. The incision is developed through the tissues to allow vertical exposure of the femoral vessels and long saphenous vein and can easily be extended proximally or distally should more extensive control be required (Fig). The wound is closed in layers, paying careful attention to precise approximation of the corresponding wound edges. In our experience, the lazy S incision effects excellent healing and results in fewer groin complications; in light of Tremblay's anatomic study, this may be partly explained by the vertical portions of the incision being off-center from the femoral artery, minimizing the disruption to the trunks of the cutaneous vasculature. As observed in Endean's commentary, groin wound breakdown is probably multifactorial, and we also surmise that the S shape across the flexing portion of the groin helps dissipate the tension that might otherwise disrupt a straight wound running across that dynamic surface (Video, online only). eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIyZDllZTZlNzc3OGIyZjE4ODAzNDczY2RjZWM2YjJjYyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc4MDU3Mzg2fQ.CCirkuvJP6EE3VTiyhu_T3QTwEet-OZrndJnZ1P3qGQ1L-idOTlzFPuaRR_o-3Akd9jQ86WSZ_FHqcm4GV7Da-JFaNX2llmLH6VrTjHSnvfQQMbw6jLvbeq6AYm4fQT4vkRyOuFyZjVLcZwiCQRX9VopOVKip0WmDbfbgnxkcnVGsDPQ6PQEFMCdK398VTEhQ-zOBv_y9CCBYKaGFedI7e3Joo0sWwKsvxzUW3SQTIrqJHalcQus158fXKbkOu2ZSH07sjHxFmIdsMmokUV-4eQG1LSWKZw0wMgK3aglBZzUNJPvqeYHalx-HfO0BkGwTKI1YHGccd1NfM_exr_oWw Download .mp4 (5.91 MB) Help with .mp4 files Video (online only)The lazy S-shaped incision at 6 weeks demonstrating movement of the wound with hip flexion. Cutaneous vascularization of the femoral triangle in respect to groin incisionsJournal of Vascular SurgeryVol. 64Issue 3PreviewThe purpose of this anatomic study was to describe the cutaneous vascularization of the femoral triangle and its variation to evaluate the potential consequences of the classic incisions used in vascular surgery. The ultimate goal was to suggest surgical approaches that would take into account the vascularization of the inguinal region to potentially reduce the vascular lesions and wound complications at the groin. Full-Text PDF Open Archive